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Catherine M. Wittgen, MD; Charles H. Andrus, MD; Stephen D. Fitzgerald, MD; Lawrence J. Baudendistel, MD; Thomas E. Dahms, PhD; Donald L. Kaminski, MD

Arch Surg. 1991;126(8):997-1001.

Abstract
• Laparoscopic cholecystectomy uses carbon dioxide, a highly diffusable gas, for insufflation. With extended periods of insufflation, patient arterial carbon dioxide levels may be adversely altered. Patients were selected for laparoscopic cholecystectomy using the same criteria as for open cholecystectomy. Twenty patients (group 1) had normal preoperative cardiopulmonary status (American Society of Anesthesiologists class I), while 10 patients (group 2) had previously diagnosed cardiac or pulmonary disease (class II or III). Demographic, hemodynamic, arterial blood gas, and ventilatory data were collected before peritoneal insufflation and at intervals during surgery. Patients with preoperative cardiopulmonary disease demonstrated significant increases in arterial carbon dioxide levels and decreases in pH during carbon dioxide insufflation compared with patients without underlying disease. Results of concurrent noninvasive methods of assessing changes in partial arterial pressures of carbon dioxide (end-tidal carbon dioxide measured with mass spectrographic techniques) may be misleading and misinterpreted because changes in partial arterial pressures of carbon dioxide are typically much smaller than changes in arterial blood levels and, unlike arterial gas measurements, do not indicate the true level of arterial hypercarbia. During laparoscopic cholecystectomy, patients with chronic cardiopulmonary disease may require careful intraoperative arterial blood gas monitoring of absorbed carbon dioxide.

(Arch Surg. 1991;126:997-1001)

Author Affiliations
From the Departments of Surgery (Drs Wittgen, Andrus, Fitzgerald, and Kaminski) and Anesthesiology (Drs Baudendistel and Dahms), St Louis (Mo) University Hospital.

Footnotes
Accepted for publication April 28, 1991.

Read before the 98th Annual Meeting of the Western Surgical Association, Scottsdale, Ariz, November 14, 1990.

Reprint requests to the Department of Surgery, St Louis University Hospital, 3635 Vista Ave and Grand Blvd, PO Box 15250, St Louis, MO 63110 (Dr Andrus).

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